SAFE Manual

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Appendix 1.

INTERVENTION MANUAL for SAFE (Systemic Autism-related Family Enabling): an early

intervention for families of children with autism and Asperger Syndrome

1. Systemic Family Therapy.

Systemic Family Therapy focuses on promoting positive changes in the relationships within families

rather than the isolated behavior of individuals in the family (Dallos & Draper, 2015). Difficulties

are seen to be maintained or exacerbated by family dynamics including the organization of families,

communicational patterns and repetitive interaction sequences of problems. The combination of these is

encapsulated in the idea of the formation of ineffective attempted solutions to their problems which

rather than offering solutions can aggravate their difficulties. Systemic Family Therapy embodies a range

of approaches and techniques for helping families to explore and re-organise their understanding,

relationship patterns, emotional connections and problem-solving abilities (e.g. Monteiro, 2016). It

Multi-Family Therapy whereby groups of families work together to assist and facilitate change,

effectively acting as consultants for each other. The SAFE program employs both these versions of

Systemic Family Therapy with three single family sessions to explore in detail each family’s needs; and

two group sessions using concepts and techniques from Multi-Family Therapy

2. Multi-Family Therapy

Multi-Family Therapy is a recognised treatment approach which aims to provide a more empowering,

flexible and intensive form of family intervention than single family therapy (Asen & Scholz, 2009). In

Multi-Family Therapy similar techniques are employed to those used in single family therapy, but

families are encouraged to work together, to be proactive in solving their own problems Multi-Family

3. Family Models

The SAFE program incorporates a range of concepts and techniques by integrating systemic and

attachment based family models, in particular The Circle of Security Intervention (Powell et al., 2014)

and Attachment Narrative Therapy developed by co-applicant Professor Rudi Dallos (Dallos, 2006). In

the SAFE intervention, these systemic and attachment models have been combined with an emphasis on

visual materials and active, play-based approaches designed to be appropriate for families of children

with autism.

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4. Autism friendly

SAFE has been developed in collaboration with children with autism and their families to be autism

friendly. Given the evidence in the literature for a visual processing style, communication difficulties and

restricted interests among people with autism, the advice we have received from families is in line with

recognizes that parents are often extremely well-informed and prefer an approach which recognizes their

competencies and helps them to feel empowered rather than de-skilled by therapy.

Session 1 (3 hours Multi-Family Therapy for parents/carers): Families act as ‘consultants’ for each other

exploring:

• Introduction and overview of the program, online materials and aims: using ideas from

attachment theory, systemic family therapy

• Initial discussion, identifying needs, prior experiences of services, what has been helpful and

unhelpful

• Discussions regarding impact of autism on family life, successes, challenges and problems,

comparing themselves to other families

• Central concerns regarding autism shared by many families, social anxiety, understanding

relationships and emotions

• Description of the Circle of Security (COS) model (See Figure 1 below) to the families. The COS

intervention and the graphic designed around it are designed to help parents increase awareness

of their children’s needs and whether their own responses meet those needs. With increased

awareness parents can expand their moment-to-moment parenting choices where needed. The

model, therefore, encourages the potential to break the stranglehold of problematic patterns.

Discussion can include: the parents as a secure base and haven, procedural memory, parents’

attachment needs, implicit responding, children as miscuing.

• Deconstructing problematic cycles. Mapping a core problem, such as conflicts at bedtime, or

mealtime or in a super market in terms of a cycles of actions, thoughts and feelings

• Each family will also act as ‘reflective consultants’ to the other families regarding their problems

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Figure 1. Graphic based on the Circle of Security (COS)

Session 2 (3 hours home visit - whole family session):

• Discussion of homework task

• Self/Autism Mapping activity (SAM). SAM is initiated by introducing the child to two figures

representing ‘Just me’ and “Me and autism’ (See Figure 2). Redrawing these figures can involve

• Developmental perspective, how the influence of the autism may alter in different contexts and,

reduce, expand as they develop

• Area of Special Interest (ASI). The child and the parents discuss a special interest that many

children with a diagnosis of autism show. Such areas can be seen as demonstrating both special

abilities and ‘gifts’ but also an indication of the condition.

• Therapist and child engage in a discussion around the child’s ASI and focus on how elements of

the area may contain metaphors about other aspects of their lives, indirect references to key

people in their lives

• Parents are invited to engage in the ASI with their child as a way of joining and connecting with

them

• Consideration of how our own childhood attachment experiences shape how we respond,

parenting styles, emotional responses

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• Mapping the family’s genogram with a focus on: transitions, similarities and differences between

family members, parenting styles, attachment patterns – ways of coping with emotional needs

and provision of comfort

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Break

• View video tape of a family problematic scenario: analyse and discuss in terms of: a) what

aspects of the child’s behavior appear to be typical vs autistic, b) how they would respond, c)

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• View sections of the DVD recordings of the Story Stems

• Feedback from parents/carers regarding implementing ideas from the programme.

• Future challenges and developmental stages that will face the families. On-going support

available from local voluntary support workers trained in the intervention, On-going peer

support options including the online discussion forum

Homework: setting our own goals with COS in mind

Overview of the 5 sessions: What has been useful, what they have been able to implement. Future issues dilemmas

envisioned. What further support they would wish to have. Developmental perspective: how the influence of the autism may

alter, reduce; expand as the child develops cognitively and emotionally.